Abstract: The diverse materialities that form part of lived experiences of mental ill-health and its treatment have been largely overlooked in research. Arguing that such a focus is key to enhancing understandings of eating disorders, this article engages with food-centered practices in anorexia nervosa. Against the background of work that has recognized the desire to maintain their illness among some individuals, the article suggests that holding onto anorexia is a dynamic process enacted through eating as well as by avoiding food. blurred intersections between eating and not eating, edible and inedible. hat is experienced as eating may not look like eating and vice versa. As contingent forms of eating thereby emerge and dissolve through anorexia-focused practices, vectors of ingestion and assimilation come to be remapped and eating delineated as an act that may take place across corporeal surfaces and among multiple bodies. While such an engagement with materialities offers key insights into anorexia, it also contributes to a wider theorizing of the act of eating within food studies literature; the article asks what eating is, as well as what forms it takes. This problematizes taken-for-granted relationships among eating, bodies, and food. Their dislocations demonstrate eating to produce and reconfigure, as well as displace or break down, materialities.
Keywords: anorexia nervosa, corporeality, desire, eating, (im)materiality, self-starvation
With a focus on the materialities and immaterialities of bodies and food, this article explores (not) eating practices among individuals with anorexia. Through these it asks two key questions: How might an attention to material encounters between bodies and food offer insights into key aspects of the experience of anorexia? And, in turn, how does tracing these encounters within the specific context of anorexia enhance critical understandings of eating? The former, then, calls for an attention to the often-overlooked role of materialities in lived experiences of mental ill-health, while the latter seeks to contribute to food studies literature by interrogating the act of eating and theorizing its myriad forms.
To explore these questions, the discussion draws on data from two qualitative studies within large National Health Service (NHS) inner-city mental health trusts in England: The first involved participant observation and interviews with individuals being treated in an eating disorders inpatient unit (EDU) (2007–8) and the second comprised interviews with users of eating disorders outpatient, daypatient, and inpatient services (2013–15). Alongside these, the article draws on anthropological participant observation and interviews conducted on pro-anorexia websites (2005–13) as well as on academic and media discussions of eating disorders.
The aim of this analysis is not to unearth the causes of eating disorders. Rather, acknowledging anorexia to be profoundly dangerous and distressing, this article extends a recent recognition of the “desire” (Lavis 2011, 2016) to hold onto their existing anorexia among some individuals. This has illustrated that not eating maintains an illness that is profoundly dangerous and distressing and yet that may offer a painful and precarious way of coping with day-to-day life and distress.
Such desire gives rise to a very felt and lived paradox, which underpins the following discussion: to be anorexic one must eat as little as possible and yet to hold onto anorexia (if that is desired) one must also eat enough to stay alive. Situating our analysis within this moment of contradiction elucidates that holding onto the illness is a dynamic process enacted through practices which draw into encounter the messy and malleable materialities of food and anorexia. Through these, eating is constantly reconfigured so that it may feel as unlike eating. These affective navigations of food give rise to fractures and multiplicities of eating; it is disassembled and reassembled, and takes multiple forms.
Thus, having begun by asking what anorexia is, the article unfolds by increasingly problematizing what eating is. It does this by engaging with the three forms that most frequently emerge from participants’ narratives: bodily incorporation; eating through the skin; and shared eating. These are presented in a narrative sequence that increasingly problematizes what eating is and does, as well as its relationship to food and bodies. Beginning with a normative imagining of eating as the individual taking of food into the body, it is first spatially repositioned to take place across bodily surfaces before becoming an act that can be shared among bodies. These permutations illustrate that eating may be agential or fearfully accidental, and they demonstrate individuals’ struggles with both food and anorexia, as each is extremely distressing.
Paying attention to food in relation to an illness more habitually framed in terms of its absence thereby offers a way to trace how body/food encounters are simultaneously positioned outside, and yet central to, anorexia. This has significant implications for understandings of the complexities of anorexia. Acknowledging these, throughout its analysis, the article importantly maintains a focus on the realities of living through the illness—the slippages and losses of agency, the fear and suffering. It comprises a recognition of the way in which not eating may not be fully agential, or even desired, and yet it balances this with an engagement with the voices of individuals themselves. To disallow either to overshadow the other, the article seesaws between these diverse forms of eating and consists of an exploratory feeling around the edges of eating, food, and bodies, rather than an analytical fixing of their boundaries.
This materially-informed analysis thereby also intersects with wider scholarly concerns. As the food-centered practices of anorexic participants problematize any easy assumptions regarding what eating is, this article seeks to contribute to food studies literature by theorizing the act of eating; it interrogates and challenges eating’s relationships with tasting, swallowing, and digesting, and explores the agencies of both eater and eaten.
It has been suggested that to take account of food as a nexus of material, symbolic, and political “stuff,” it is necessary to pay attention to eating bodies (cf. Abbots and Lavis 2013). Engaging with the food-centered practices of individuals with anorexia underscores a similar but further need to focus attention on that eating body—on “what bodies are and do when they eat” (Probyn 2000: 14) and, importantly, do not eat.
This elicits interrogation of the role of the eater, and non-eater, in the production of materiality as bodies and foods are made and displaced in relation to one another. Engaging with recent discussions of food’s “vibrant materiality” (Bennett 2010) and the ways in which objects become edible (cf. Evans and Miele 2012; Roe 2006), the article traces the many moments during which food slip-slides into what we might term, for want of a better word, “non-food,” and vice versa, as eatable and edible are drawn into conflict through the (non)eating body.
As such, these explorations of (not) eating elucidate the “liminality” (Turner 1967) of food as participants mobilize it across conceptual and corporeal thresholds by salivating and swallowing, viewing and chewing. This highlights the necessity of taking account of uncertainty and contingency in relationships among eating and bodily materialities, as these may become dislocated both in the context of anorexia and more widely. Recognizing that eating absents or materializes food, as well as anorexia, demonstrates how the very “stuff” of food and bodies is drawn into question through mundane moments of consumption and starvation.
What Is Anorexia? Desire and (Not) Eating
There is no doubt that anorexia nervosa is a painful, frightening and dangerous illness. Yet, while participants’ narratives are replete with distress and suffering, many also resonate with an ambivalent “desire” (Lavis 2011, 2016) to maintain the illness. Anorexia is often described as a “part of me” and during fieldwork, Eva, who was an inpatient at the time, illustrated this claim: “If a doctor took a scalpel and tried to cut him [anorexia] out, he’d just leave his shoelaces behind anyway.” Participants also frequently refer to the illness as a “friend” (see also Grahame 2009; Serpell et al. 1999), and in her interview Indira said: “I think it becomes a bit of like a friend, like it’s a… It’s almost like it’s a world that you live in, that’s separate from everybody else.” Many reasons have been put forth in interviews for describing anorexia in this way. Friendship is circumscribed with articulations of how it can be “helpful” and “protective,” and may even offer a “safe space” or a “cloud away from everyone else.” Such narratives are often interwoven with descriptions of the illness also as “torturing,” “awful,” and “hell,” with these juxtapositions occurring within the serrated space of the same sentence.
As such, participants’ accounts elucidate how anorexia can become an (extremely painful) way of being for some individuals with the illness. As “living through anorexia” is conceptualized in interviews as a way of “living through” day-to-day life or distress, the illness is described as a coping strategy. Participants can find it extremely painful, know that it is dangerous, and yet they may also want to hold onto it, at least temporarily. Anorexia can therefore be felt to be both an illness and a modality of caring for oneself (see Lavis 2015a).
Unlike the plethora of popular imaginings of anorexia as a quest for thinness against all odds, many research participants have not expressed a wish to become thin. Rather, the desire articulated by some individuals is, albeit ambivalently, directed at holding onto the illness. Against this background, thinness becomes important only as a temporally later way in which to visually check and measure the continuing presence of this “friend” anorexia (see Lavis 2014). Such a looking beyond thinness in analysis is in line with the work of other scholars who have also engaged with the practices, meanings, and subjectivities of individuals with anorexia (cf. Eli 2014; Gooldin 2008; Lester 2014). Reflecting on the desire to maintain anorexia thereby shifts our understanding of the illness. It highlights the necessity of acknowledging the extreme suffering that anorexia causes, while also suggesting that we need to take into account how it comes to be important to some individuals. Underpinned by subjectivities of anorexia’s protective “care,” it is this that sets in motion practices of (not) eating.
In her interview, Miriam said: “If you eat you’ve given in, you’ve stuffed yourself silly and… and that’s not right. You just shouldn’t do that.” She described eating as threatening—both to herself and anorexia. With this sense of threat in mind, it is clear how eating can come to be feared; in her interview, Lydia said:
If I was in a situation where I had to eat something that I was really uncomfortable with, erm…just to sort of, satisfy the people and keep it quiet I suppose, it could, it could play on me to the point of tears where I would get very, very upset and would not be able to sleep that night thinking about what I’d eaten.
This discomfort—even fear—of food also illustrates how not eating may not always be entirely agential; in her interview, Kayley said: “It’s not exactly a choice, kind of. Well, it’s not like you’re just thinking, like, ‘Oh, I won’t eat because…’ It, it’s more, kind of, like, it’s more that you can’t, really.” In spite of this blurring of agency and its loss, it is clear what eating and not eating do in (and to) anorexia. But, it is less obvious what eating and not eating are, where the boundaries between them lie, and what counts as “food” in this context.
Participants’ narratives thereby illustrate the fundamental and viscerally felt tension of living with anorexia that I set out in the introduction to this article: to be anorexic you must eat as little as possible, and yet to hold onto anorexia, if that is desired, you must also eat enough to stay alive (see also Lavis 2013). From this, anorexia emerges as maintained not only by not eating but also, seemingly paradoxically perhaps, by eating. In this paradox lies the key to forging more nuanced understandings of anorexia, as well as of eating itself. It is this simultaneity of needing to eat and yet not eat that sees the act of eating perpetually reshaped and reconfigured because participants’ engagements with food suggest that eating needs to be made to be (and perhaps, fundamentally, feel) as unlike eating as possible; it needs to be contained and confined, squashed and reshaped. This underscores the practices explored throughout the rest of this article. Perhaps suggesting that reflecting on eating always necessitates a rather strong stomach, this tracing of eating’s various guises will begin by exploring how eating and bodies are turned inside out through vomiting.